MINISTRY OF PUBLIC HEALTH AND PO PULATION ......The National Plan for the Elimination of Cholera...

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REPUBLIC OF HAITI MINISTRY OF PUBLIC HEALTH AND POPULATION NATIONAL DIRECTORATE FOR WATER SUPPLY AND SANITATION NATIONAL PLAN FOR THE ELIMINATION OF CHOLERA IN HAITI 2013-2022 SHORT TERM PLAN 2013-2015

Transcript of MINISTRY OF PUBLIC HEALTH AND PO PULATION ......The National Plan for the Elimination of Cholera...

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REPUBLIC OF HAITI

MINISTRY OF PUBLIC HEALTH AND POPULATION

NATIONAL DIRECTORATE FOR WATER SUPPLY AND SANITATION

NATIONAL PLAN FOR THE ELIMINATION OF CHOLERA IN HAITI

2013-2022

SHORT TERM PLAN 2013-2015

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REPUBLIC OF HAITI

Elimination�of�Cholera�in�Haiti���

IMPLEMENTATION�IN�THE�SHORT�TERM��2013–2015�

PortͲauͲPrince,�Haiti�December�2012

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TABLE�OF�CONTENTS��������� � � � � � � � � � � ���������� � � �� � � � � � � � � � � � � � � ��� � � ����PAGE�

I�Ͳ�CONTEXT�� � � � � � � � � � � � � � � � �� ��4�

II�Ͳ�EPIDEMIOLOGY�OF�THE�CHOLERA�EPIDEMIC�IN�HAITI�� � � � � � � � � � ��6�

III�Ͳ�OBJECTIVES�OF�THE�ACTION�PLAN� � � � � � � � � � � � �����������11�

IV�Ͳ�SHORTͲTERM�INTERVENTIONS� � � � � � � � � � � � � �����������12�

V�Ͳ�EXPECTED�RESULTS� � � � � � � � � � � � � � � �����������15�

VI�Ͳ�INDICATORS� � � � � � � � � � � � � � � � �����������16�

VII�Ͳ�ACTIVITIES�AND�COST�OF�IMPLEMENTING�THE�PLAN�OF�ACTION�� � � � � � � �����������16�

VIII�Ͳ�MONITORING�AND�EVALUATION� � � � � � � � � � � � �����������17�

IX�–�ACTION�PLAN�(SUMMARY),�SHORTͲTERM,�2013–2015/FINANCING�REQUIRED� � � � � �����������19�

���������DINEPA:���������������������Ͳ�INSTITUTIONAL�STRENGTHENING� � � � � � � � � �����������20���������������� Ͳ�ACCESS�TO�POTABLE�WATER� � � � � � � � � � �����������24�

��������������������������������������� Ͳ�TREATMENT�OF�WASTEWATER�AND�EXCRETA��� �� � � � � � �����������27����������PUBLIC�HEALTH:�������Ͳ�MANAGEMENT� � � � � � � � � � � � �����������32�� ������������������������������� Ͳ�VACCINATION� � � � � � � � � � � � �����������36�� � � �������� Ͳ�MEDICINES�AND�INPUTS� � � � � � � � � �� �����������37�� � � �������� Ͳ�EPIDEMIOLOGICAL�SURVEILLANCE� � � � � � � � � �����������42�� � � � Ͳ�HEALTH�PROMOTION� � � � � � � � � � � �����������44�

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I�Ͳ�CONTEXT�

Ten� months� after� the� devastating� earthquake� of� 10� January� 2010,� Haiti� experienced� one� of� the� largest� cholera�

epidemics� in�modern�history.�The � first � cases � of � cholera �were � discovered � in � Haiti � in �October � 2010 � in � the �

Central �Department. �A �month � later, �cholera �spread� into �all �of �Haiti �and � to � the �Dominican �Republic. �As�

of�3�July�2012,�there�had�been�a�total�of�577,858�cases�of�cholera�in�Haiti,�among�which�312,449�had�been�hospitalized�

and�7,413�had�died.�This�represents �the � largest �epidemic �ever �recorded � in �a �single �country � in �the �world. �In�

the�Dominican�Republic,�the�first�case�of�cholera�was�reported�in�November�2010.��In �the �Dominican �Republic, �the �

first � cholera � case � was � reported � in � November � 2010. � By � 31 � December � 2012,� there � had � been � 29,433�

suspected �cases, �422 � fatalities �and �a � fatality �rate �of �0.7% � in �the �Dominican �Republic. �There � is �a �risk �of �

cholera �becoming �endemic �on �the � island �of �Hispaniola. � � �

The � different �manner � in �which � the � disease � spread� in � the � two � countries � is � explained � in � part � by � health �

conditions � that �persist �on � the � island. �At � the � start �of � the �epidemic, � it �was �estimated � that, � in �Haiti, �31% �

of � the � population � had � no � access � to � potable � water, � and � 83% � of � the � population � had � no � access � to �

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adequate � facilities � for � excreta � disposal. 1� The � lack� of � good � hygiene � practices � among � most � of � the �

population, � and � particularly � among � groups � without � access � to � basic � health � services,� was � among � the �

factors � that � furthered � the � rapid � spread � of � the � disease. � In� addition, � even � before � the � earthquake � in �

January � 2010 � and � the � cholera � outbreak � in � October � of � that � same � year, � 46% � of � the � Haitian � population �

had �no �access � to �health � care. �Access � is �defined � in �part �by � the �distance � that �must �be � traveled � to � reach �

the �nearest �health �center�and � in �part �by � the � fact� that �a � large �portion �of � the �population �cannot �pay � for �

the �cost �of �services. � �

Environmental � degradation � is � extreme � in � Haiti � and � has � a � significant � impact � on � the � availability � of � and �

access � to � potable �water, �which � constitutes � an � important � factor � for � health � and � the � spread � of � cholera. � �

Throughout �the �entire �country, �poor �waste �management �practices �and �the � lack �of �modern �sewerage �and �

sanitation �systems �are �among �the �environmental �factors �that �affect�the �health �of �the �population. � � �

Despite � the � cholera � epidemic � in � Latin � America � and � the � Caribbean � in � the � 1990s, � which � killed �

approximately �12,000 �people � in �21 �countries, � the � two �countries �of �Hispaniola �were � free �of �cholera �prior �

to � the � October � 2010 � outbreak. � The � epidemic � in � the � 1990s � was � finally � controlled � after � eight � years � of �

international � public � health � efforts � and � massive � investments � in � infrastructure,� water � supply, � and �

sanitation � in �the �region. �

1 Source : WHO/UNICEF Jo in t Moni to r ing P rogram, 2012 .

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II�Ͳ�EPIDEMIOLOGY�OF�THE�CHOLERA�EPIDEMIC�IN�HAITI�

The � cholera � epidemic � in �Haiti � began � in �October � 2010 � and �was � attributed � to �Vibrio � cholerae, � serogroup �

01, � serotype �Ogawa,�biotype �El �Tor. �The � first �case �was �detected � in � the �Central �Department, �after �which �

the � infection �spread �to �the �neighboring �department �(Artibonite) �before �spreading �gradually �to �the �other�

departments. � As�of� the� second�week�of�2013,� the�Ministry�of�Public�Health� and�Population�had� reported� a� total�of�

639,610�cases,�7,962�deaths,�and�353,288�hospitalizations.�Even � though � the � infection � spread � rapidly � across � the �

country, � it � is � interesting �to �note �that �two �geographic �areas�always �reported �more �cases �than �the �others:�

the �metropolitan �area �of �PortͲauͲPrince �and �the �neighboring �communes � in �the �Western �Department �and �

the �Artibonite �Department. �As �of �endͲDecember �2012, �those �departments �represented �26.9% �and �20.2% �

of � all � cases, � respectively. � The � overall � mortality � rate � is � estimated� at � 1.2%, � compared � to � 1.4% � for �

hospitalized �cases. �Figure �1 �below �shows �the �epidemiological �curve �for �the �period �from �20 �October �2010 �

to �8 �January �2013. �

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Cholera �Epidemic: �Situation �as �of �the �Second �Week �of �2013�New �Cases �Seen �and �Overall �Mortality

x From �the �42nd �week �of �2010 �to �the �2nd �week �of �2013, �the �Ministry �of �Public �Health �and �Population �reported: �

639,610 �cumulative �cases, �353,288 �hospital izations �(54% �of �cases �seen), �and �7,962 �deaths �(overall �mortality �of �1.2%), �of �which �5,090 �occurred � in �hospitals �(hospital �mortal ity �of �1.4%). �

x For �the �second �week �there �were �1,379 �cholera �cases, �905 �hospital izations, �and �24 �deaths, �20 �of �them � in � institutions �(overall �mortality, �1.7%; �hospital �mortality, �2.2%). �

x Did �not �report: �GrandeͲAnse. �

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Comparison�of�Cases�Seen�during�the�First�52�Weeks�of�2011�and�2012

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Trends�in�the�Incidence�of�Cholera�(from�the�42nd�epidemiological�week�of�2010�to�the�2nd�epidemiological�week�of�2013)�

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Total�Incidence�per�1,000�Population�by�Department�Haiti,�1st–2nd�Week,�2013���

Department�Total�Incidence�per�1,000�

Population�

Northwest� 2.8�

Grande�Anse� 3.5�

Nippes� 3.6�

Southeast� 4.2�

South� 6.4�

Artibonite� 8.8�

North� 10.5�

West� 10.9�

PortͲauͲPrince� 12.8�

Northeast� 18.7�

Central� 20.1�

Haiti� 10.1�

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III�Ͳ��OBJECTIVES�OF�THE�ACTION�PLAN�

a. Goal�of� the�Action�Plan�–�The�ultimate�goal�of� the�Action�Plan� is � to � eliminate � cholera � from � the � island � of �

Hispaniola � through � technical � and � financial � support � from � the � international � community � and �

binational �coordination. ��

b. Specific� Objectives� –� In � order � to � prevent � deaths � and � reduce � the � suffering � caused � by � the � cholera �

epidemic, � the � Haitian � government’s � main � strategy� is � to � put � in � place � an � integrated � approach � to �

prevent �and �stop�the �secondary �transmission �of �cholera � in �Haiti. � �

From � this �perspective, � the �Haitian �government �has �established � the � following � specific �objectives � to �

be �attained:�

i. Increase�access �to �potable �water �to �at � least �85% �of �the �population;��

ii. Increase�access �to � improved �sanitary �and �hygiene �facilities �to �at � least �90% �of �the �population;��

iii. Increase� collection � of � solid �waste � in � the �metropolitan � area � of � PortͲauͲPrince � to � 90% � and � in �

secondary �cities �to �80%;�

iv. Strengthen �the �public �health �system �to �facilitate �access �to �health �care �services�for �80% �of �the �

population;�

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v. Strengthen � epidemiological � surveillance � for � timely � detection � of � all � cholera � cases � and � other �

diseases �under �surveillance �through � improved � information�management;�

vi. Intensify � education � of � the � public � about � household � hygiene � and � an � understanding � of � food �

hygiene.�

IV�Ͳ�SHORTͲTERM�INTERVENTIONS�

The � National � Plan � for � the � Elimination � of � Cholera � calls � for � the � acceleration � over � the � first � two � years � of �

systematic � emergency �measures � at � the � level � of � the � plan’s � four � strategic � areas: � water � and � sanitation, �

management, �epidemiology, �and �health �promotion. � � It �was �thus �decided �that �the �shortͲterm �actions �will �

focus � on� preventing � the � transmission � of � cholera � from � one � person � to � another � through � the � use � of �

potable �water �for �consumption, �hand �washing, �and �food �handling.��

In�the�short�term,�the�Ministry�of�Public�Health�and�Population�will,�first,�undertake�the�following:�

a. Continue �with �emergency �measures �as �part �of �health �care �provision �and �with �treatment �with �the �

oral �rehydration �solution;�

b. Strengthen � the � network � of �multipurpose � community � health � agents � in � order � to � have � one � agent �

for �every�500 �to �1,000 �population � in �areas�at �risk �for �cholera. �During �the �course �of �the �epidemic,�

their �functions �will �be � l imited �to:�

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– Conducting �home �visits �targeting �households �where�there �are �suspected �cholera �cases;��

– Providing � regular� reports � to � the �Ministry � of � Public �Health � and � Population � about � detected �

cholera �cases;�

– Facilitating � the � treatment �of �persons � infected �with �cholera � following �ministry �protocol � for �

rehydration �with � the � help � of � oral � rehydration � solution, � accompanying � patients �when � they �

undertake �hygiene �and �sanitary �practices � in �order � to �protect �other �members �of � the � family, �

and, � when � necessary, � referring � patients � to � a � higher � level � of � care � in � the � health � system �

(cholera �treatment �centers, �health �centers,�or �communal �hospitals);�

– Promoting � and � supporting � efforts� by � the � population � to � follow � food � hygiene � measures �

according � to � the � directives � of � the � Ministry � of � Public � Health � and � Population � and � the �

National �Directorate �for �Water �Supply �and �Sanitation �(DINEPA);�

– Providing � health � education � and � promoting � hygiene � and � behavioral � changes � such � as � hand �

washing;�

– Carrying �out �chlorine �residue �tests �of �water �consumed � in �households �and �community �water �

pipe �systems;��

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– Administering � chlorine � (and/or � teaching � heads � of � families � how � to � add � chlorine) � to �

household �cisterns �for �drinking �water. ��

c. Coordinate �and � supervise � the �hygiene �and �health �education�messages � that �are �disseminated �by �

the � various � entities � involved � in � combating � cholera. � Ensure � that � the � community � health � agents�

and � personnel � from � nongovernmental � organizations � (NGOs) � are � sufficiently � trained � to � deliver �

messages � from � the �ministry � and �DINEPA � to � sensitize � the � population � about � the � risks � of � and � the �

protection �measures �against �cholera;�

d. Ensure � that � all � health � professionals � are � trained � in � the � fundamentals � of � combating � cholera � and �

that � they � promote � through � their� own � daily � practices � the � messages � that � champion � access � to �

potable �water, � sanitation, � and � hygiene � in � health � centers � and � community � clinics, � and � at � public �

awareness �events;��

e. Establish � a � network � of � community � health � clubs � to � increase � efficiency � and � reduce � the �workload �

of �the �community �health �agents; �

f. Establish � local �community �health �clubs � throughout � the �country � (run �by �health �workers) � in �order �

to �promote �hygiene �and �other �public �health � issues; �

g. Vaccinate�the�population� in�atͲrisk�or�stillͲvulnerable�areas� (30�to�40�percent�of�the�population;�approximately�

600,000�people).�

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Secondly,�DINEPA�will:��

h. Continue �with �emergency �measures �for �the �provision �of �safe �water � in �areas �at �risk �of �cholera, �as �

well � as � with � the � installation � of � excreta � disposal � systems� for � hospitals, � health � centers, � and �

households �that�need �them; ��

i. Coordinate �DINEPA � interventions �with � those � of � the �Ministry � of � Public �Health, � concentrating � on �

emergency �actions � in �areas �being �handled �by �community �health �agents; ��

j. In� collaboration� with� the� Ministry� of� Public� Health� and� Population,� ensure� that� residents� of� communities�

identified�as�being�at�risk�for�cholera,�and�that�do�have�access�to�safe�drinking�water,�have�access�to�consumable�

water�through�the�appropriate�use��of�chlorine�liquid�or�tabs;�

k. Coordinate�with� the�Ministry�of�Public�Health�and�Population� in� the� training�of�community�health�agents�and�

municipal� sanitary� technicians,� including� training� on� water� conservation,� promotion� of� hygiene,� and� water�

analysis�and�an�understanding�of�chlorine�production�equipment.��

V�Ͳ��EXPECTED�RESULTS�

1. The � risk � of � transmission � of � Vibrio � cholerae � by � using � water � that � is � insufficient � in � quality � and �

quantity � is � eliminated � through � repairs � to � existing � networks � and � the � construction � of � new �water �

supply � systems � in � all �mediumͲsize � or � large � cities � (that � do � not � currently � have �water� supply), � as �

well �as � in �rural �agglomerations �judged �to �be �a �priority;��

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2. The � risk �of � transmission �of �Vibrio � cholerae �due � to �poor �disposal � and �management �of � excreta � is �

eliminated �from �the �entire �national �territory �through �the �promotion �of �sanitary �excreta �disposal �

systems, � in � situ, � in � urban � and � rural � areas, � as � well � as � the � construction � of � sanitary � sewerage �

accompanied �by �wastewater �treatment �systems � in �certain � large �cities �and �treatment �systems �for �

sludge � in �other�mediumͲsized �cities; �

3. The � institutional � capacity � of � DINEPA � is � strengthened � at � the � national � level � and � in � its �decentralized �structures. �

VI�Ͳ�INDICATORS�

BY�THE�END�OF�2015:������ Ͳ�� The�annual�cholera�incidence�rate�in�Haiti�is�reduced�from�3%�to�ч�0.5%�

����������� Ͳ�� 80%� of� the� population� living� in� areas� of� the� country� where� there� is� active� secondary�

transmission���of�cholera�washes�their�hands�after�defecating�and�before�eating��

VII�Ͳ�ACTIVITIES�AND�COST�OF�IMPLEMENTING�THE�ACTION�PLAN�

The� activities� of� the� different� Action� Plans � are� shown� in� the� table� below,�which� follows � the� four � areas�

defined�for�the�project:�water�and�sanitation,�health�services�and�health�care�management,�epidemiology, �

and�the�promotion�of�health,�hygiene,�and�nutrition.� In�the�table�the�activities �are�grouped�under� lines�of�

16

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action� to � be� undertaken� to� achieve� the� defined� objectives.� The� total � cost � for � implementat ion � of � the �

Action �Plan � for �2013–2015 � is �est imated �to �be �US$443,723,100.��

VIII�–�MONITORING�AND�EVALUATION�

FollowͲup � of � implementation � of � the � Action � Plan � will � be � the � responsibility � of � a � Steering � Committee �

comprised �of �representatives � from �the �ministries � involved �and �technical �and � financial �partners. �The �role �

of � the � committee � is � to � facilitate � the � coordination � of � policy � and � strategy.� It � is � desirable � to � have �

participation � by � the � Ministries � of � Public � Works, � Public � Health, � Education, � Communications, � the �

Environment, � and � the � Interior � and � Local � Communities. � The � committee � will � meet � twice � a � year � and �

whenever �else �the �representative �of �one �of �the �executing �agencies �(DINEPA, �Ministry �of �Health, �Ministry �

of � Transport � and� Public �Works, �Ministry � of � the � Interior � and � Local � Communities) � calls � for � convoking � a �

meeting.�

Operational � implementation �of � the �Action �Plan �will �be �supervised �by �a �Technical �Committee �made �up �of �

highͲ level � officials � from � DINEPA, � the �Ministry � of � Public � Health, � the �Ministry � of � Public �Works, � and � the �

Ministry �of �the � Interior, �as �well �as �representatives �from � international �agencies �cooperating � in �one �of �the �

Action �Plan �areas. �The �DirectorͲGeneral �of �the �Ministry �of �Public �Health �or �his �designated �representative �

will �preside �over�this �committee.�

17

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The � Technical � Committee � will � meet � quarterly � in � order � to � review � progress� in � implementation � of � the �

Action � Plan, � propose � corrective �measures � as � needed, � and � prepare � reports � for � the � Steering � Committee. �

The �members � of � the � Technical � Committee �will � carry � out � field � visits � as � needed � in � order � to � evaluate � the �

results �of �the �project.��

An � evaluation � of � implementation� of � the � Action � Plan � will � be � undertaken � at � the � end � of � each � year. �

Similarly, � an � audit �will �be � conducted � at � the �halfway �point � and � at � the �end �of � the �plan’s � implementation �

period.�

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IX�–�PLAN�OF�ACTION�(SUMMARY),�SHORTͲTERM,�2013–2015/FINANCING�REQUIRED�YEARS� FINANCING�IN�US$�SPHERE�

OF��ACTIVITY�

EXECUTING�AGENCIES�AND�AREAS�OF�INTERVENTION� 2013Ͳ2015� 2013Ͳ2015� YEAR�1�

EXPLANATORY�NOTES�(Expected�Results)�

ѕ�DINEPA� � 91,481,000� 33,075,000� �

��Ͳ��Drinking�water�supply�� X� 50,560,�000� 15,720,000� DINEPA�and�its�decentralized�structures�are�strengthened�

��Ͳ��Treatment�of�wastewater�and�excreta� X� 22,700,000� 10,450,000� Activities�of�the�water�supply�and�sanitation�sector�are�coordinated,�monitored,�and�regularly�evaluated�

��Ͳ�Institutional�strengthening�of�DINEPA�� X� 18,221,000� 6,905,000�Cities�and�towns�benefit�from�wastewater�collection�and�treatment�service�that�complies�with�social�and�environmental�standards��

ѕ�Ministry�of�Public�Works,�Transport,�and�Communications/Ministry�of�the�Interior�and�Local�Governments��

� 231,500,000� 1,500,000� �

��Ͳ�Institutional�strengthening�of�solid�waste�management�

X� 1,500,000� 1,�500,000� Access�to�water�supply�is�improved�throughout�the�country�

ARE

A�

WATER�AND�SANITATION�

��Ͳ�Waste�collection�and�treatment��� X� 230,000,000� � Each�Region�has�at�least�one�excreta�treatment�site�

ѕ�Ministry�of�Health� � 94,518,100� 81,�473,000� �

��Ͳ�Health�care�services�� X� 39,694,100� 26,�649,000� Management�of�diarrheal�diseases�improved�and�completely�adequate�

��Ͳ�Inputs/Essential�medicines�� X� 54,824,000� 54,824,000� By�2015,�all�inputs�are�available�in�sufficient�quality�and�quantity��

��Ƒ�Epidemiology�� � 4,350,000� 4,�200,000� �

��Ͳ�Quality�of�information� X� 1,350,000� 1,200,000� Strengthening�of�epidemiological�surveillance�with�a�view�toward�rapid�and�concerted�action�

��Ͳ�Research�capacity� X� 3,000,000� 3,000,000� Effective�epidemiological�surveillance�with�strengthening�of�microbiological�and�environmental�surveillance�

Ƒ��Health�Promotion� � 26,324,000� 37,678,000� �

��Ͳ�Hygiene�practices�� X� 3,580,000� 11,590,000� Understanding�and�skills�in�cholera�prevention�measures�promoted�among�the�population�at�risk��

��Ͳ�Institutional�strengthening� X� 8,010,000� 4,154,000� Strengthened�vigilance�by�the�population�in�the�face�of�the�country’s�cholera�threat�

��Ͳ�Food�hygiene� X� 1,240,000� 1,240,000�Food�hygiene�practices�strengthened�in�areas�at�risk�for�cholera�in�order�to��reduce�the�incidence�of�nutritional�and�diarrheal�illnesses���

��Ͳ�Micronutrient�deficiency� X� 9,340,000� 18,540,000� Fight�against�micronutrient�deficiencies�strengthened�in�areas�vulnerable�to�cholera�

ARE

A��O

F�PU

BLIC�HEA

LTH�

��Ͳ�Hospital�hygiene�� X� 4,154,000� 2,154,000� Environmental�protection�in�health�institutions�strengthened�

� ѕ�COUNTRY�TOTAL�� 443,�723,100� 157,�926,100� �

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STRATEGIC�INTERVENTION�FRAMEWORK��

���������SPHERE�OF�ACTIVITY:���WATER�AND�SANITATION��� � ������COMPONENTS:��

o STRENGTHENING�DINEPA�o ACCESS�TO�POTABLE�WATER�o ACCESS�TO�SANITATION�

ACTIVITIES� INDICATORS�FOR�ACTIVITIES�� BASEYEARS�1�AND�2�

FOR�YEAR�1� EXPLANATORY�NOTES�

1.�Organization�of�sectoral�governance.� Number�of�new�Technical�

Center�Operations�(CTE)�in�20 15� 1,�000,000

US$100,000�per�CTE.��

SPHERE:�WATER�SUPPLY�AND�SANITATION � ���COMPONENT:�STRENGTHENING�DINEPA

20

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21

ACTIVITIES� INDICATORS�FOR�ACTIVITIES�� BASEYEARS�1�AND�2�

FOR�YEAR�1� EXPLANATORY�NOTES�

place�and�operational�Number�of�new�Water �Supply �and �Sanitation �Committees �(CAEPA)�in�place�and�operational�

90 30� 400,000

Number�of�Communal�Administrative�Councils�(CASEC)�actively�involved�in�the�water�supply�and�sanitation�sector��

0 30� 5,000

Number�of�school�inspectors�actively�involved�in�monitoring�the�Alliance�for�Water,�Sanitation,�and�Hygiene�in�School�(EAHMS)�

0 500� 5,000

Number�of��Multipurpose�Community�Health�Agents�actively�involved�in�the�water�supply�and�sanitation�sector�

0 500� 10,000

Number�of�localities�recorded� 0 ?� 1,000,000Number�of�base�maps�completed�and�regularly�updated�

0 1� 5,000

Number�of�water�point�outlets�geoͲreferenced�

0 ͲͲͲͲͲ� 50,000

Coordination�and�control�of�all�actors�intervening�in�the�sector�across�the�country�through:�

- Guidance�and�support�for�new�structures,�prioritizing�sensitive�areas�(CTE,�CAEPA)�- information�meetings�and�workshops�with��partners�and�local�authorities�(CASEC,�school�inspectors,�multipurpose�community�health�agents,�CAEPA)�- Establishment�of�an�exhaustive�database�on�support�to�the�water�supply�and�sanitation�sector�- Coordination�meetings�and�workshops�at�all�levels�(national�and�regional�sector�tables,�sanitation�platform,�WASH�cluster,�coordination�of�collection)�

���

Number�of�annual�coordination�meetings�held�

24 36�

Establishment�of�a�followͲup�and�evaluation�system.�Development�of�

Number�of�evaluation�tools�in�place� 0 1�

50,000

US$20,000�per�CAEPA.��At�least�90�CAEPA�will�be�operational�in�2022.��The�base�map�shows�the�water�supply�and�sanitation�situation�of�a�group�of�localities�and�a�communal�section.��The�evaluation�tool�allows�for�understanding�and�analyzing�the�progress�of�water�supply�and�sanitation�activities�in�real�time.���An� autonomous� system� linked� to� the�prevalence�of�cholera� should�be� in�place�in� order� to� ensure� the� followͲup� and�evaluation� of� immediate� responses�planned�and�implemented.�

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22

ACTIVITIES� INDICATORS�FOR�ACTIVITIES�� BASEYEARS�1�AND�2�

FOR�YEAR�1� EXPLANATORY�NOTES�

decisionͲmake�tools,�holding�of�evaluation�sessions.��

Number�of�evaluation�sessions�carried�out� 0 4�

1.1 Result�Water�supply�and�sanitation�known�and�regularly�updated�

1.2�Result�Water�supply�and�sanitation�sector�activities�coordinated,�monitored,�and�regularly�evaluated�

Percent�of�the�population�benefiting�from�the�support�of�local�authorities�� � �

2,525,000

Number�of�procurement�specialists�recruited�by�DINEPA�to�strengthen�this�service�in�order�to�ensure�implementation�of�the�Plan��

0 6� 144,000

Two�persons�to�be�recruited�for�rapid�actions�at�the�central�level�and�one�person�by�OREPA�for�arrangement�and�followͲup�of�small�local�contracts.���Estimated�cost�of�US$2,000�x�6�per�month�

2.Ͳ�Strengthening�of�DINEPA�structures�Recruitment�of�qualified�staff�to�strengthen�the�water�supply�and�sanitation�response�at�the�national�level�Ͳ�Additional�staff�for�DINEPA�headquarters�and�decentralized�structures.�Ͳ�Staff�attached�to�sanitation�at�the�central�level�and�in�the�regional�water�supply�and�sanitation�offices�(OREPAs)�

Number�of�sanitation�staff�in�place��

8 12� 144,000

Ͳ��Recruitment�of�staff�for�the�response�structure�during�the�dry�season�

Number�of�water�supply�technicians��recruited�for�the�response�during�the�dry�season�

0 3� 144,000

Ͳ���Payment�for�TEPACs�as�of�2013�Number�of�operational�TEPACs�

258 280� 906,000

12�staff�members�paid�an�average�of��US$2,000��Three�technicians�paid�an�average�of��US$2,000��280�community�water�supply�and�sanitation�technicians �(TEPACs) �x�18�months�x�$500�+�22�x�6�months�x�$500)��

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23

ACTIVITIES� INDICATORS�FOR�ACTIVITIES�� BASEYEARS�1�AND�2�

FOR�YEAR�1� EXPLANATORY�NOTES�

Ͳ� Training� of� staff� at� DINEPA�headquarters�

Number�of�staff�trained�in�sanitation�

10 25�

Ͳ� Technical� training� of� staff� from�OREPAs,�CTEs,�and�CAEPAs��

Number�of�OREPA,�CTE�and�CAEPA�staff�trained���

10 2,550�

Ͳ�Ongoing�training�of�sanitary�officers,�health�agents,�and�school�inspectors�on�topics�linked�to�water�supply�and�sanitation��

Number�of�sanitary�officers�and��multipurpose�community�health�agents�trained�

500 200�

10,000 Over�two�years��

2.1�Result:�Water�supply�and�sanitation�staff�strengthened� � � 1,348,000� �

3.�Support�for�innovation�Ͳ�Feasibility�studies�on�the�provision�of�potable�water�through�the�use�of�surface�water�

Number�of�feasibility�studies�completed��

2 �

Ͳ�Studies�related�to�sanitation� Number�of�studies�launched� � �

2,000,0005�million�Haitians�live�in�rural�areas,�so�increasing�coverage�by�10%�comes�to�$50�million�

ͲTechnical�assistance�in�sanitation� International�personnel�maintained�in�their�posts� � �

96,000

3.1�Result:�Studies�conducted�and�concluded� � � 2,096,000�

SUBTOTAL:�Institutional�Strengthening�of�DINEPA�� �

6,905,000�

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ACTIVITY� INDICATORS�FOR�ACTIVITIES� BASE� YEARS�1�AND�2� FOR�YEAR�1� EXPLANATORY�NOTES��

1.�Construction,�rehabilitation,�expansion,�and�maintenance�of�water�supply�systems�- In�the�area�of�metropolitan�PortͲauͲPrince�

Number�of�additional�systems�built���

ͲͲͲ ͲͲͲ

- In�mediumͲsized�cities�and�small�urban�centers�

Number�of�production�systems�completed�or�expanded��

ͲͲͲ ͲͲͲ

- In�rural�areas�Number�of�new�and�operational�rural�potable�water�supply�systems��

ͲͲͲ

10,000,000�

�1.1Ͳ Result:�2%�of�new�homes�in�the�metropolitan�area�of�PortͲauͲPrince�are�equipped�with�a�potable�water�system��%�of�homes�with�access�to�potable�water�in��the�metropolitan�area�of�PortͲauͲPrince�

50% 52%

Result:�13.5%�of�new�homes�in�15�mediumͲsized�cities�(30,000�to�100,000�inhabitants)�and�23�small�urban�centers�(between�10,000�and�30,000�inhabitants)�are�equipped�with�a�potable�water�system�%�of�homes�with�access�to�potable�water�in�24�secondary�cities�

10,000,000�

Populations�that�currently�have�access�only�to�river�water�benefit�from�priority�interventions�that�enable�them�to�have�access�to�potable�water�(treatment�networks,�boreholes,�or�stations�for�potable�water�in�households,�etc.)�

WATER�SUPPLY�AND�SANITATION ���������������������� ��COMPONENT:�ACCESS�TO�POTABLE�WATER

24

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25

ACTIVITY� INDICATORS�FOR�ACTIVITIES� BASE� YEARS�1�AND�2� FOR�YEAR�1� EXPLANATORY�NOTES��

1.2Ͳ Result:�7%�of�new�homes�in�rural�areas�(towns�of�3,000�to�10,000�inhabitants�and�localities�of�less�than�3,000)�have�access�to�a�potable�water�system�%�of�homes�in�rural�areas�with�access�to�potable�water��

53% 60%

Number�of�new�sources�where�the�perimeter�is�clean�

ͲͲͲ ͲͲͲ

Number�of�new�sources�where�the�perimeter�is�protected�

ͲͲͲ ͲͲͲ

Number�of�networks�providing�chlorinated�water�

ͲͲͲ ͲͲͲ�

2.�Preparation�and�implementation�of�a�water�quality�control�program�including:�- Cleaning�of�perimeters�of�collection�sources�(2�x�4�OREPAs)�

- Construction�of�protection�perimeters�

- Chlorination�of�100%�of�existing�networks�

- Making�water�treatment�products�available�in�identified�localities��

Number�of�distribution�centers�for�treatment�products�in�place�

ͲͲͲ 100

1,000,000�

2.1Ͳ�Result:�Populations�that�currently�have�access�only�to�river�water�benefit�from�immediate�priority�interventions�that�enable�them�to�have�access�to�household�potable�water�systems��%�of�the�population�having�access�to�water�of�which�the�quality�is�guaranteed�

ͲͲͲ 100% 1,000,000

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26

ACTIVITY� INDICATORS�FOR�ACTIVITIES� BASE� YEARS�1�AND�2� FOR�YEAR�1� EXPLANATORY�NOTES��

3.�Preparation�and�implementation�of��water�supply�and�sanitation�responses�in�emergency�situations�

Number�of�response�actions�by�the�Department�of�Emergency�Response�(DRU)�or�by�humanitarian�organizations�following�a�catastrophe�

ͲͲͲ ͲͲͲ 720,000

DRU�staff�$20,000/month,�financed�until�June�2013�by�the�World�Bank.���$10,000/month�planned�to�finance�the�interventions.�Technical�assistance�$40,000/month.�

3.1�Result:�A�response�structure�during�the�dry�season�is�established�by�teams�from�the�Ministry�of�Health�and�DINEPA.�3.2�Result�2:�Areas�identified�as�residual�sources�of�transmission�areas�benefit�from�an�immediate�and�conclusive�technical�response.�3.3�Result�3:�100%�of�areas�declared�as�residual�outbreaks�have�benefited�from�control�actions�from�water�supply�points��%�of�the�population�living�in�former�residual�source�areas�benefit�from�potable�water��

ͲͲͲ� 100%� 4,720,000�

SUBTOTAL:�Access�to�Potable�Water�� �

15,720,000�

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WATER�SUPPLY�AND�SANITATION ��COMPONENT:�TREATMENT�OF�WASTEWATER�AND�EXCRETA

ACTIVITY� INDICATORS�FOR�ACTIVITIES� BASE� YEARS�1�AND�2� FOR�YEAR�1� EXPLANATORY�NOTES�

1.�FollowͲup�of�sanitation�activities�and�support�for�local�governments:��

- Continued�support�costs�for�training�300�TEPACs�

- Equipping�local�governments�for�inspection�and�followͲup�of�sanitation�actions�

Number�of�local�governments�benefiting�from�support�for�improved�involvement�in�wastewater�management�

0 20� 100,000

- Training,�materials�and�communication�tools�for�the�CASECs�

Number�of�CASECs�active�in�promoting�sanitation��

0 20� 50,000

20�total�local�governments�(….�intermediate�cities,�…..�secondary�cities,…..rural�localities)�are�already�programmed,�20�other�local�governments�identified�by�the�Ministry�of�Health�will�need�to�be�added�to�the�list�of�priorities�on�the�basis�of�cholera�residue.���However,�the�group�of�local�governments�will�be�reached�through�the�TEPACs�to�ensure�and/or�strengthen�planning�of�future�actions�to�monitor�those�in�progress.��

1.�Result:�Local�officials�involved�in�wastewater�management�and�in�effective�followͲup�of�the�sector.�

%�of�the�urban�population�benefiting�from�support�and�followͲup�by�local�officials�responsible�for�wastewater�management.�

150,000

27

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2.�Preparation�and�implementation�of�a�Sanitation�and�Hygiene�Promotion�Plan�(PAH)��Communication�and�Promotion�of�Awareness��- Development�and�dissemination�of�educational�materials��

Number�of�teaching�kits�designed/prepared�and�disseminated�for�use�with�the�different�targeted�groups��

6 6�

Target�groups:�schools,�regional�and�local�markets,�other�public�spaces�(sports�facilities,�stations,�etc.),��religious�festivities�and�other�events��where�large�numbers�of�people�gather,�health�centers�

- Carrying�out�campaigns�in�cities�

Number�of�campaigns�carried�out�in�cities�

0 3� 8�annual�campaigns�by�cities���

- Integration�of�CAEPAs�in�the�promotion�of�sanitation�and�hygiene�

Number�of�CAEPAs�benefiting�from�a�sanitation�focal�point�

Each�CAEPA�will�be�assigned�to�designate�a�sanitation�focal�point���

- Preparation�of�an�appropriate��film�documentary���

Extent�of�the�dissemination�of�the�documentary�film��

30 30�Film�to�sensitize�the�public�at�large�about�the�situation�regarding�cholera�prevention�and�control.��

- Competitions�about�safety��between�groups�from�different�localities,�through�CASECs�and�CAEPAs�

Number�of�competitions�held� 0 10�Competitions�in�Artibonite,�the�Northeast,�and�the�Central�Departments�for�a�total�of�10�networks�

Training�- Training�and�use�of�multipurpose�community�health�agents�in�the�PAH�

Number�of�health�agents�identified�and�working�actively�in�the�PAH��

1,500 3,000�1�agent�for�an�average�of�3�localities,�or�1�agent�per�1,000�habitants�in�rural�areas�

- Training�of�masons�in�cities�and�localities�involved�

Number�of�masons�trained�� 0 100�

2,000,000

An�average�of�3�masons�in�secondary�cities�

28

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- Support�for�trained�masons��

Number�of�trained�masons�known�in�their�localities��

� ��

Result:�Population�reached�by�key�sanitation�messages�%�of�the�urban�population�that�has�access�for�the�first�time�to�household�sanitation��through�the�zero�subsidy�approach� 80% 82%� �

Result:�Rural�population�sensitized�about�the�need�to�use��adequate�sanitary�facilities�for�defecation�(%�of�the�rural�population�with�access�to�a�household�sanitary�facility)�

50% 55%�

2,000,000

Number�of�sewerage�networks�regarding�which�studies�are�conducted�

1 3� 1,000,000

Number�of�sewerage�networks�for�which�construction�is�undertaken�

0 2� 1,000,000

Number�of�new�excreta�treatment�stations�built�to�standards�

2 6� 1,200,000

Construction�of�semiͲcollective�sewerage�networks�and�wastewater�treatment�stations�in�the�main�cities�in�the�country�(25):��- Study��- Construction��- Control�and�FollowͲup��- Environmental�and�social�standards�� Number�of�bayakous�formalized� 0 3� 100,000

In�2022,�studies�will�be�completed�in�15�of�the�30�cities�with�more�than�30,000�inhabitants��

In�2022,�stations�will�be�built�in�at�least�25�cities�

In�2022,�at�least�3�bayakous�per�city�of�at�least�300,000�inhabitants�will�be�formalized�

Construction,�repair,�management,�and�maintenance�of�public�toilets:��- In�schools�

Number�of�public�or�mixed�schools�equipped�with�adequate�sanitary�facilities�

460 1,000� 5,000,000

In�2022,�all�public�schools�will�have�adequate�sanitary�facilities�regularly�used�by�the�beneficiaries�

29

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30

Number�of�markets�equipped�with�adequate�sanitary�facilities�

0� 100�

241� 500�

- In�other�public�areas�

Number�of�public�or�mixed�health�centers�equipped�with�adequate�sanitary�facilities�Number�of�other�targeted�public�areas�equipped�with�adequate�sanitary�facilities�

0� 100�

The�unit�cost�per�public�location�is�between�$10,000�and�$40,000�depending�on�the�intervention�required,�that�is,�construction�or�repair�

Result:�Cities�and�towns�benefiting�from��wastewater�treatment�and�disposal�services�that�are�in�accordance�with�social�and�environmental�standards��

Impact:�%�of�the�total�population�that�benefits�from�a�healthy�environment�

8,300,000�

Each� Region� has� at� least� one� excreta�treatment�site���

SUBTOTAL:�Treatment�of�Wastewater�and�Excreta�� �

10,450,000��

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INDICATORS�OF�ACTIVITIES�ACTIVITIES�

ACCORDING�TO�THE�ACTION�PLAN� FOR�YEAR�1�

SUBTOTAL:��Institutional�Strengthening�of�DINEPA� 74,000,000 6,905,000�

SUBTOTAL:�Access�to�Potable�Water� 81,000,000 15,720,000�

SUBTOTAL:�Treatment�of�Wastewater�and�Excreta� 59,600,000 10,450,000�

GRAND�TOTAL� 214,600,000 33,075,000�

31

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STRATEGIC�INTERVENTION�FRAMEWORK��

SPHERE�OF�ACTIVITY:�PUBLIC�HEALTH��

COMPONENTS:��

o HEALTH�CARE/MANAGEMENT�o MEDICINES/INPUTS�o EPIDEMIOLOGICAL�SURVEILLANCE�o HYGIENE�PRACTICES��

��

����SPHERE:��HEALTH�CARE������������������������������ ������������������������������ �����������COMPONENT:�MANAGEMENT

INDICATORS:��By�2015,�there�are�no�more�deaths�from�cholera�in�public�or�private�health�institutions�or�facilities,�with�the�exception�of�cases�associated�with�other�illnesses.���

32

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33

YEARS�1�AND�2��RESULTS�

�ACTIVITIES�

2013/2014� 2014/2015�

FINANCING�2013Ͳ2015�

�EXPLANATORY�NOTES�

1.1.�Organization�of�community�meetings�to�transfer�knowledge�about�management�to�community�leaders��

X� X� Community�involvement�in�combating�cholera�in�the�10�departments�

1.2.�Organization�of�home�visits�by�health�agents�� X� X�Home�visits�in�vulnerable�areas��

1.3.�Training�of�field�agents�in�prevention�and�management�of�diarrheal�diseases���

X� X�

1.4.�Training�of�technical�and�support�staff�(health,�brigadiers��and�rapid�intervention��brigades,�560�people�and�teams�for�the�10�departments)�

� �

1.5.�Preparation�of�a�contingency�plan�by�commune� X� X�

1.6.�Support�for�training�and�organization�of�the�community�for�surveillance�of�the�ongoing�availability�of�inputs�at�the�local�level�

X� X�

1,500,000��

Providers�(6,000)�will�be�trained�in�cholera�management�

1.7.�Establishment�of�oral�rehydration�points�(PRO+)�in�areas�without�sanitary�facilities�and�that�are�difficult�to�access�(365)�

X� X�

�Management�of�diarrheal�diseases�significantly�improved�and�completely�adequate��

1.7ͲIdentification�and�regular�control�of�stock,��positioning�of�inputs�in�appropriate�locations�at�the��departmental�and�communal�levels�

X� X�

2,000,000�

Artibonite:�63;�Northeast:�27;�Northwest:�7;�Central:�30;�Grande�Anse:��47;�West:��80;�Nippes:�32;�South:�24;,�North:�40;�Southeast:��15��

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34

YEARS�1�AND�2��RESULTS�

�ACTIVITIES�

2013/2014� 2014/2015�

FINANCING�2013Ͳ2015�

�EXPLANATORY�NOTES�

1.8.�Construction/placement�of�locations�for�management�of�patients�with�diarrhea�in�health�facilities�(infectious�disease�management�unit)�

X� X� 3,000,000

Departmental�hospitals:��10�Community�reference�hospitals:��30��Health�centers�without�beds:�…�Health�centers�with�beds:�…�

1.9.�Establishment�of�emergency�funds�at�the�departmental�level� X� X� 3,325,000

Funds�to�be�made�available�to�10�BD�to�enable�the�DD�to�address�outbreaks�

1.10.�Harmonization�of�standards�for�the��construction�of�cholera�treatment�centers�in�health�centers�and�hospitals�� X� X� Leadership�of�the�Organization�of�Health�

Services�will�be�involved�

1.11.�Development/standardization�and�dissemination�of�standards�and�procedures�for�the�prevention�of�infection�in�health�facilities�������� �

X��X�

1.12.��Development,�standardization,�and�dissemination�of�standards�for�the�handling�of�cadavers����

X� X�

5,000,000

This�activity�will�be�carried�out�at�the�central�level�

1.13.��Hiring�of�additional�staff��(1,099�health�professionals)�needed�in�institutions�

X��

X��

5,000,000�266�nurses,��400�auxiliaries,��133�doctors,�20�laboratory�technicians��

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35

YEARS�1�AND�2��RESULTS�

�ACTIVITIES�

2013/2014� 2014/2015�

FINANCING�2013Ͳ2015�

�EXPLANATORY�NOTES�

1.14.�Supervision:�application�of�standards�for�management,��decontamination,�and�verification�of�alerts��

X� X� Supervision�will�be�at�several�levels�and�several�groups�will�be�involved��

1.15.�Response�to�alerts�in�the�event�of�outbreaks� X� X�

660,000

Management�of�outbreaks�

SUBTOTAL� 20,485,000 �

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YEARS�1�AND�2� FINANCING�RESULTS� ACTIVITIES�

2013/2014� 2014/2015� 2013Ͳ2015�EXPLANATORY�NOTES��

2.1.�Operationalization�of�the�vaccination�plan� X� �

2.2.�Design�and�production�of�management�tools�(vaccination�cards,�registration�forms,�recordͲkeeping�forms,�etc.)�

X� �

2.3.�Identification,�microͲplanning,�and�eventually�the�preregistration�of�beneficiaries�� X� �

2.4.�Training�of�providers� X� �

2.5.�Communications�and�social�mobilization�activities�(radio�and�television�spots�banners,�posters,�community�meetings,�launch�activities,�etc.)

X� �

2.6.��Strengthening�the�logistics�of�the�cold�chain�X� �

2.7.�Operations�(the�actual�vaccinations)�X� �

2.8.�FollowͲup�and�evaluation� X� �

6,164,100Strengthening�of�departments�in�terms�of�materials�and�staff.�Purchase�of�vaccines�and�inputs.

�2Ͳ�Reduction�in�the�incidence�of�cholera�through�the�targeted�areas���

SUBTOTAL� 6,146,1000

GRAND�TOTAL� 26,649,100

SPHERE:�HEALTH�CARE������������������������������ ��������������������� �������������������� �COMPONENT:�VACCINATION

36

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INDICATOR:�By�2015,�all�inputs�are�available�in�sufficient�quantity�and�quality.�

YEARS�1�AND�2� FINANCING�RESULTS� ACTIVITIES�

2013/2014� 2014/2015� 2013Ͳ2015�EXPLANATORY�NOTES��

3.1.�Standardization�of�tools�for�the�management�of�cholera�inputs� X� X�

3.2.�Updating,�disclosure,�and��application�of�standards�(signing�of�a�protocol�agreement�and�a�convention�protocol)�

X� X�

3.3.�Updating�of�the�information�database/uniformity�of�management�tools/implementation�of�Channel�software�

X� X�

3.4. Supervision�and�awareness�spots� X� X�

360,000

3.5. Purchase�of�medicines�and�inputs�to�support�health�institutions�in�emergency�responses�linked��to�cholera�

X� X� 50,000,000Purchase�of�Lactated�Ringer’s�solution,�antibiotics,�chlorine�products,�and�necessary�materials�

3.6. Human�resource�needs�–�Recruitment�of�staff�� X� X� Pharmacists�(13),�secretaries�(2),�and�other�staff�(5)�

�3.�Improved�logistics�to�make�inputs�and�medicines�available�and�accessible�to�health�centers�for�the�timely�handling�of�cholera�cases��

3.7. Strengthening�the��Ministry’s�supervisory�capacity�of�the�Center�for�the�Distribution�and�Supply�of�Inputs�(CDAI)�(vehicles,�cargo�trucks,�etc.)�

X� X�

1,464,000

SPHERE:�HEALTH�CARE����������������� �������������������������������� ����������������COMPONENT:�MEDICINES/INPUTS

37

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3.8. Training�of�managers�in�the�use�of�stock�management�tools�

X� X�

3.9. Creation�and�operation�of�a�pharmacovigilance��unit�

X� X�

3.10. Coordination�meetings�with�partners� X� X�

3.11. Construction�and�rehabilitation�of�the��CDAI� X� X� 3,000,000 �

SUBTOTAL�� �

54,824,000 �

38

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INDICATOR:�Epidemiological�surveillance,� including�microbiological�and�environmental�surveillance,� is�carried�out�at�the�national� level�and� in�100%�of�the�targeted�areas�as�of�2014.�

YEARS�1�AND�2� FINANCING��RESULT�

�ACTIVITIES�

2013/2014� 2014/2015� 2013Ͳ2015�

�EXPLANATORY�NOTES�

4.1.�Acquisition�of�information�technology�equipment�and�materials� X�

4.2.�Communications�management�support�system�(telephone,�Internet)�

�X�

4.3.�Logistical�support�(vehicles,�maintenance,�and�repairs)� X�

�Availability�of�materials�and�equipment�for�better�information�management�

4.4.�Support�staff�to�strengthen�the�team���

850,000

Institutional�strengthening��

4.5.�Preparation�of�a�list�of�illnesses�under�surveillance� X�

4.6.�Workshops�on�the�validation�of�information� �

4.7.�Daily�verification�and�weekly�analysis�of�alerts� X�

4.�Strengthening�of��epidemiological�surveillance�(including�microbiological�and�environmental�surveillance�in�collaboration�with�DINEPA)��as�a�result�of�adequate�training,�early�detection�of�cases,��and�timely�alerts�at�the�departmental�and�national�levels�with�a�view�toward�rapid�and�concerted�action�

4.8.�Development�of�tools�for�surveillance��by�communities�� X�

100,000

Ensure�better�information�management�for�decisionͲmaking�

SPHERE: EPIDEMIOLOGICAL�SURVEILLANCE� ��������������COMPONENT:�QUALITY�OF�INFORMATION

39

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40

YEARS�1�AND�2� FINANCING��RESULT�

�ACTIVITIES�

2013/2014� 2014/2015� 2013Ͳ2015�

�EXPLANATORY�NOTES�

4.9.�Revised�training�manual�for�health�agents�available�

X��

4.10.�Revision�of�cholera�surveillance�tools� X�

4.11.�Technical�assistance�for�the�study�and�updating�of��surveillance�systems� X� 50,000

4.12.�Updating�of�standards�and�procedures������ �

4.13.�Production�and�dissemination�of�the�aboveͲmentioned�documents� X�

4.14.�Preparation�of�a��legal�framework/RSI�2005�(legal�framework�requiring�private�clinics�to�report�cholera�cases)�

���

4.15.�Updating�of�laboratory�diagnosis�protocols�(technical�assistance)�������

���

200,000

Ensure�better�information�management�for�decisionͲmaking�

4.16.�Training�of�community�health�agents��in�the�use�of�tools�for�community�surveillance��� X�

���������������������

4.17.�Training�of�providers�(doctors,��nurses,�auxiliaries,�and�health�officers)�

X��

�Ensure�better�information�management�for�decisionͲmaking�

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41

YEARS�1�AND�2� FINANCING��RESULT�

�ACTIVITIES�

2013/2014� 2014/2015� 2013Ͳ2015�

�EXPLANATORY�NOTES�

4.18.�Training�of�laboratory�technicians�(departmental)� X�

4.19.�Training/rotation�of�departmental�and�centralͲlevel�epidemiologists��� X�

4.20.�Ongoing�training�on�analysis�and�preparation�of�reports� X�

4.21.�Training�for�investigative�teams�and�for�departmental�response� X�

4.22.�Updating�and�dissemination�of�performance�indicators�obtained� X�

4.23.�Updating�of�supervisory�control�tools�and�supervision�of�departmental�and�regional�laboratories�carried�out�regularly.�Operational�situation�room�at�the�central�and�departmental�levels�

X�

4.24.�Regular�dissemination�of�an�epidemiological�bulletin�on�the�cholera�situation���

X�

Ensure�better�information�management�for�decisionͲmaking

SUBTOTAL 1,200,000

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INDICATOR:�100%�of�alerts�are�verified�and�investigated,�and�investigative�reports�are�available.�

YEARS�1�AND�2�RESULT� ACTIVITIES�

2013/2015�FINANCING�� EXPLANATORY�NOTES��

5.1.�Organized�local�response�in�targeted�areas�and�in�the�rest�of�the�country�in�accordance�with�standards�� X�

5.2.�Inputs�and�reagents� X�

5.3.�Capacity�for�prepositioning�stock,�rapid�testing,�and�others� X�

200,000Have�reliable�information�for�timely�decisionͲmaking�

5.4.�Repairs/construction�of�new�departmental�laboratory�clinics�involved�in�epidemiological�surveillance�� �

5.5.�Installation�of�space�in�laboratories�to�be�equipped�for�waterͲquality�surveillance�� X� 1,500,000

5.6.�Equipment,�laboratory�accessories�and�reagents,�and��furnishings

�X��

780,000

Have�reliable�information�for�timely�decisionͲmaking�

5.�Epidemiological�surveillance�made�effective�with�a�strengthening�de�of�microbiological�and�environmental�surveillance,�the�establishment�of�a�network�of�laboratories�for�the�decentralization�of�biological�capacity,�and�the�integration�of�investigation,�research,�collection,�and�analysis�of�samples�to�better�and�more�rapidly�understand�the�evolution�of�diseases�

5.7.�Logistical�support�(�transport�system�);��institutional�support�(recruitment�of�qualified�staff)� X� ��320,000

SPHERE:�EPIDEMIOLOGICAL�SURVEILLANCE���������������������������COMPONENT:�RESEARCH�CAPACITY

42

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5.8.�Preparation�of�an�applied�research�program�at�the�hospital�level� �

5.9.�FollowͲup�on�the�resistance�of�Vibrio�cholerae�to�antibiotics� X�

5.10.�Preparation�of�a�national�microbiological,�immunological,�environmental,�and�socioͲanthropological�research�agenda� X�

200,000

5.11ͲProposals�for�appropriate�protocols��Technical�assistance�requested� X�

SUBTOTAL������������������������������������� 3,000,000�

Have�reliable�information�for�timely�decisionͲmaking

GRAND�TOTAL���������������������������������������������������������������������������������������������������������������������������4,200,000�

43

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INDICATOR:�By�2015,�70%�of�the�population�washes�their�hands�after�defecating�and�before�eating.��

YEARS�1�AND�2�

FINANCING��RESULTS�

�ACTIVITIES�

2013�Ͳ�2015� 2013�Ͳ�2015�

�EXPLANATORY�NOTES��

6.1.�Intensification�of�interpersonal�communication:��Home�visits�and�community�meetings��

X�480,000

Interpersonal�communication�is�the�best�way�to�reach�families�and�other�organized�groups�in�the�community��

6.2.�Mass�communications�campaign:�ͲProduction�of�audio�and�video�material� X�

6.3.�Dissemination�to�the�media��(including�community�media)� X�

6.4.�Evaluation�of�campaign� X�

1,500,000This�strategy�of�using�the�media�allows�for�covering�several�targets��

�6.�Knowledge�and�skills�related�to�cholera�prevention�measures�promoted�among�the�atͲrisk�population�through�the�integration�of�health�promotion�aptitudes�in�the�primary�health�care�program��

6.5.�Design/production�of�educational�materials:�cartoons,�sketches/mimes,�pamphlets,�brochures�and�posters,�songs,�popular/participatory�theater,�jingles���

X� 600,000

The��production�of�a�range�of�materials�will�facilitate�attaining�the�objectives�because�it�can�reach�specific�groups,�particularly�in�remote�areas��

SPHERE:�HEALTH�PROMOTION����������������������������������������������������COMPONENT:�HYGIENE�PRACTICES�

44

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���

6.6.�Acquisition�of�communications�equipment��

X� 1,000,000The�equipment�is�necessary�for�the�production�as�well�as�the�dissemination�of�materials��

YEARS�1�AND�2�

FINANCING�1�AND�2��RESULTS�

�ACTIVITIES�

2014/2015� 2014/2015�

EXPLANATORY�NOTES��

6.7.�Training�of�community�health�agents:�Ͳ�Operationalize�a�network�of�community�health�agents�in�communes�at�risk�for�cholera��

X�

6.8.�Preparation�of�a�work�guide�for�community�agents� X�

6.9.��Acquisition�of�work�equipment�for�community�health�agents� X�

6.10.�Supervision�and�followͲup�on�the�network�of�agents� X�

5,080,000Strengthening�the�capacity�and�skills�of�community�personnel�can�help�improve�community�management��and�save�lives�

�Strengthened�vigilance�among�the�population�in�the�face�of�the�threat�of�cholera�in�the�country��

6.11.�Training�of�1,200�health�inspectors�Strengthening�the�network�of�health�inspectors� X� 1,490,000

Strengthening�the�capacity�and�skills�of�community�personnel�can�help�improve�community�management��and�save�lives�

45

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6.12.�Adaptation�of�training�curriculum�Adapt/design�the�work�guide�for�inspectors��in�terms�of�the�new�Haitian�context�

X�

6.13.�Training�of�senior�technical�staff�of�the�Directorate�for�Health�Promotion�and�Environmental�Protection�(DPSPE)�and�other�government�institutions�involved�

X�

6.14.�Meeting�of�central�and�departmental�coordinators�Ͳ�Intersectoral�collaboration�meetings�

X�

620,000Strengthening�the�capacity�and�skills�of�community�personnel�can�help�improve�community�management��and�save�lives�

6.15.�Sectoral�strengthening:�ͲRecruitment�of�staff�at�the�central,�departmental,�and�communal�levels�

X�

6.16.�Acquisition�of�logistical�support:���Vehicles�� X�

6.17.�Material�and�equipment�for�quality�control�of�drinking�water�from�water�supply�networks�and�water�points���

6.18.�Technical�assistance� X�

820,000

Structural�strengthening�is�a�way�to�guarantee�that�planned�activities�will�be�carried�out�

SUBTOTAL� 11,590,000

46

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YEARS�1�AND�2�FINANCING�IN�US$�RESULT� ACTIVITIES�

2013/2015� 2013/2015�

EXPLANATORY�NOTES��

7.1.�Control�of�food�hygiene:�ͲPreparation/dissemination�of�a�communications�plan�for��food�hygiene�and�its�integration�into�the�DPSPE�program�

X�

7.2.�Preparation�of�a�training�guide�for��food�hygiene� X�

7.3.�Preparation�of�awareness�tools�(brochures,�posters,�etc.)� �

7.4.�Integration�of�awareness�activities�about��food�hygiene�into�health�promotion�� �

800,000This�control�has�not�been�assured�for�a�long�period�of�time.�It�is�necessary�to�start�up�the�process�of�considering�different�stages.�

7.5.�Training�of�staff�Training�and�rotation�of�health�inspectors�involved�in�the�control�of�foods���

X�

7.6�.Training�of�street�vendors,�hotel�and�restaurant�staff� X�

240,000

�7.�Food�hygiene�practices�strengthened�in�areas�at�risk�for�cholera�in�order�to�reduce�the��incidence�of�nutritional�and�diarrheal�diseases��

7.7.�Technical�assistance�for�1�year� x� 200,000

Training�of�providers�and�beneficiaries�is�necessary�to�attain�the�objectives�

SPHERE:�HEALTH�PROMOTION������������������������������������� ����������������������COMPONENT:�FOOD�HYGIENE�

47

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SUBTOTAL� 1,240,000�

YEARS�1�AND�2�

FINANCING�IN�US$�

RESULT� ACTIVITIES�2013/2015� 2013/2015�

EXPLANATORY�NOTES��

8.1.�Improvement�in�the�nutritional�management�of�cholera�Revision�of�the�cholera�management�protocol�and�introduction�of�zinc�in�addition�to�the�oral�rehydration�solution�

X�

8.2.�Integration�into�guides�used�in�cholera�awareness�campaigns,�the�introduction�of��zinc�in�addition�to�the�oral�rehydration�solution�

X�

8.3.�Training�of�Ministry�staff�at�the�departmental�and�communal�levels�as�well�as�of�NGOs�involved�in�cholera�management�

X�

1,100,000The�benefits�from�the�introduction�of�zinc�for�the�management�of�diarrhea�have�been�proven���

8.4.�Supply�of�inputs:�Provision�of�nutritional�ration�to�malnourished�children��with�cholera�

X�

�8.�Efforts�to�combat�micronutrient�deficiencies�strengthened�in�areas�vulnerable�to�cholera��

8.5.�Supply�of�zinc�among�the�inputs�that�the�Ministry�provides�to�oral�rehydration�points�and�distributes�to�community�health�agents�

X�

6,640,000The�availability�of�inputs�is�indispensable�to�manage�and�attain�the�objectives�

48

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8.6.�Structural�Strengthening:�Strengthening�of��nutrition�unit�staff�at�the�central�and�departmental�levels�

X�1,600,000

8.7.�Logistical�support�for�supervision�of�nutrition�activities�in�the�cholera�program�

����9,340,000

Structural�strengthening�is�a�way�to�guarantee�that�planned�activities�will�be�carried�out�

� SUBTOTAL� 18,540,000

49

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YEARS�1�AND�2�

FINANCING�IN�US$�RESULT� ACTIVITIES�

2013/2015� 2013/2014�

EXPLANATORY�NOTES��

X�9.1.�Implementation�of�hygiene�control�measures�in�hospitals:�Updating�of�standards�and�procedures�for�hospital�hygiene�and�biomedical�waste�

X�

9.2.�Preparation�of�a�plan�for�surveillance�and�prevention�of�nosocomial�infections�

X���

9.3.�Design�of�nosocomial�hygiene�tools� X�

9.4.�Establishment�of�a�plan�for�the�supervision�of�hygiene�behaviors�in�health�institutions� X�

�9.�Protection�of�the�environment�in�health�institutions�is�strengthened�

9.5.�Training�session�on�hospital�hygiene�for�the�community�and�departmental�officials�who�are�responsible�for�it�(doctors,�nurses,�sanitary�officers)�

200,000The�current�situation�in�terms�of�hygiene�at�health�institutions�constitutes�a�risk�for�beneficiaries,�relatives,�and�visitors.�A�global�hospital�hygiene�plan�is�important�to�avoid�nosocomial�infections.�

SPHERE:�HEALTH�PROMOTION �������������������������������������������������COMPONENT:� HOSPITAL�HYGIENE�

50

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9.6.�Construction�of�15�wastewater�treatment�stations�Rotation�of�the�training�of�technical�staff�involved�at�hospitals�

X�

9.7.�Acquisition�of�logistical�support�(2�vehicles,�scooters,�motorized�pumps�and�accessories,�chemical�products,�and�protection�materials)�

X�

9.8.�Reevaluation�of�water�storage�structures�at�the�institutional�level�� X�

9.9.�Expansion�of�the�SISKLOR�system:�Training�of�staff�in�charge�of�disinfecting�water�and�controlling�chlorine�residue�Acquisition�of�control�kits,�disinfectant�

X�

230,000

Implementing�the�SISKLOR�system�for�quality�control�of�water�at�health�facilities�is�in�progress.�It�would�be�useful�to�expand�it�to�all�health�institutions.��

9.10.�Improvement�in�the�skills�of�providers�and�in�the�infrastructure�for�the�management�of�medical�waste�

X�

9.11.�Training�and�rotation�of�health�providers�and�support�staff�

9.12.�Acquisition�and�installation�of�equipment�for�the�treatment�of�hospital�waste�(50�incinerators).�Supplies�(garbage�cans,�bags,�scrubs,�boots,�tillage�tools,�etc.)�and�consumables��

X�

1,420,000

The�program�for�the�management�of�hospital�waste�has�been�implemented.�The�rotation�of�staff�and�the�lack�of�incinerators�explain�the�need�for�training�of�senior�staff�and�the�acquisition�of�incinerators�and�protection�gear.�

51

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9.13.�Improvement�in�the�handling�of�cadavers:�Review�and�publication�of�standards�and�procedures�for�the�handling�of�cadavers�of�patients�with�cholera�

X�

9.14.�Training�of�staff�in�funeral�homes�and�hospital�morgues�in�the�handling�of�cadavers�of�those�who�were�sick�with�cholera�� X�

9.15.�Support�for�periodic�surveillance�of�funeral�homes�and�morgues�in�health�facilities�

X�

44,000

The�handling�of�cadavers�is�one�of�the�elements�that�must�be�taken�into�account��to�disrupt�the�cholera�transmission�chain,�because�poor�handling�of�the�bodies�of�cholera�patients�often�constitutes�a�mode�of��transmission�for�the�disease�

� SUBTOTAL� 2,154,000�

�GRAND�TOTAL� 24,074,000

52

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53

INDICATORS�FOR�ACTIVITIES�ACTIVITIES�

ACCORDING�TO�THE�ACTION�PLAN� FINANCING�2013Ͳ2015�

SUBTOTAL:��Management�and�vaccination� 35,030,000 26,649,100�

SUBTOTAL:�Inputs� 63,660,000 54,824,000�

SUBTOTAL:��Epidemiological�surveillance�� 4,200,000 4,200,000�

SUBTOTAL:��Health�promotion�� 16,984,000 24,074,000�

GRAND�TOTAL� 119,874,000 109,747,100�

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